Working as a junior doctor in a busy surgical department in central London a few years ago was immensely rewarding. My colleagues and I got to see – and assist in the operating theatre with – cutting edge vascular surgery procedures using the latest devices and technologies, rubbing (sterile) shoulders with the who’s who of vascular surgery. The department had a ‘work hard, play hard’ attitude, and organised regular evenings at a local bar. This happened almost weekly, without fail. And on a school night.
The ‘work hard’ bit of the mantra came with its darker side. Ward rounds of all inpatients under the service would take place every day, and with sometimes 40+ patients this often took several hours. As the most junior member of the team, us as the foundation year 1 doctors had to do a lot of the legwork. Whilst the seniors made the management plans, we had to find the patients notes (this was before electronic health records were commonplace), document the plan and simultaneously prepare the notes for the next patient. Oh, and whatever ‘jobs’ needed doing for that patient, had to be transposed onto another list so that we didn’t forget to do them.
As well as the doctors on the ward round (consultant, registrar, FY2, FY1) there were other key characters. The nurse in charge was in attendance, so that they could be contemporaneously up to date with the management plan, and address any nursing concerns. The clinical nurse specialists were also in attendance. They had specific training and experience which made them highly specialised in the field of vascular surgery. They ran their own nurse-led clinics, staffed an advice phone and wore imposing grey tunics with a white trim.
One ward round moment sticks in particular. Once a week, the geriatrician with a special interest in perioperative medicine joined us. She saw patients who were frail or with medical comorbidities that needed attention. One patient we were seeing on the ward round, who was day 1 post-op, was very drowsy and difficult to rouse. He had a lung condition called COPD (chronic obstructive pulmonary disease) which made him prone to retaining carbon dioxide. Carbon dioxide is the waste product of respiration, which is usually expelled by the lungs. If it isn’t expelled properly it is retained (builds up) and causes drowsiness and respiratory depression, which in turn causes more CO2 to build up, and so the vicious cycle continues. People with COPD are at risk of CO2 retention, and this was the concern in his case.
“he needs a gas right NOW!”, cried the geriatrician.
Meanwhile the surgeons had already moved on to the next patient.
I saw this as an opportunity to transiently detach from the admin-filled ward round and contribute to some actual doctoring.
“I’ll do it!”, I responded, with all the vigour of an excited 18 year-old fresher pressing the buzzer for the first time on University Challenge.
I started to get my kit prepared from the nearby phlebotomy trolley.
Claire, one of the clinical nurse specialists, didn’t seem too happy with this suggestion.
“I think you should stay, and John should do the gas”, Claire proclaimed.
Her rationale was that it was Monday and I was on all week, and that I should stay on the ward round. John, however, was on a rest day the following day, and therefore was felt to be more dispensable.
I sheepishly conceded.
“Uhmmm…OK”, I replied, whilst slowly moving my tray towards John. The tray comprised an antibacterial wipe, needle, syringe, cotton bud and tape, all beautifully arranged in order of anticipated draw.
John was clearly unhappy. He took a deep breath and pushed the bridge of his glasses up his nose slightly before taking the tray off me. I could hear him muttering under his breath.
“[inaudible] making me do the gas [inaudible] bossy [inaudible] just stood there”
In no time at all, John was back with a tear-off receipt from the gas machine in his hand, ready to read it out to everyone.
“This gas is consistent with decompensated type 2 respiratory failure”, he announced.
The surgeons who were examining the stump of another patient’s recently amputated leg transiently looked up and gestured towards the geriatrician before returning to looking back down at the granulation tissue and admiring their handiwork.
At the same time, the clinical nurse specialist walked up to the head honcho, professor of surgery, whilst he was practically nose-deep in wound.
“It’s 11 o’clock now, I’m off to the charity bake sale. I’ve made banana bread!”
I looked over at John. His breathing started to become more pronounced. The blood gas result he was reading out a moment ago became crumpled as his hand turned into a fist.
“Banana…bread… ? Banana bread? BANANA BREAD?!”.
His words got louder and sharper with each iteration of the baked product.
Everyone stood to attention. The surgeons. The nurse. The geriatrician. Heck, even the drowsy patient seemed to perk up transiently.
“I was here all weekend, staying late and working like a dog. All I ever wanted to do was stay on the ward round and learn from it. But no, no education for me! I got sent off the ward round by Claire to do a gas, and now she’s swanning off to a CHARITY BAKE SALE, no less!”
“Has anyone ever thought about what I want? What if I need to go off to present an audit, or go to grand rounds, or bake bakes? What if I want to bake cakes? Has anyone ever thought of whether I want to bake cakes? I want to bake cakes! I WANT TO BAKE CAKES!”
He breathed a sigh of relief. His fist loosened. The crumpled up blood result fell to the floor.
“I…I’m sorry…I need a moment”.
He walked towards the entrance to the ward and disappeared.